Please enable JavaScript in your browser to complete this form. - Step 1 of 3Wildfire Relief Assistance Application This application allows individuals in the golf industry affected by wildfires to request financial assistance from funds raised through the CGCOA GoFundMe campaign. All information provided will remain confidential and used solely for the purpose of evaluating need and disbursing relief funds.First and Last Name *Email *EmailConfirm EmailPhone Number (including area code) *Physical Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNextEmployer Name *Employer Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePosition in the Golf Industry *How long have you worked in the golf industry? *NextCause of Hardship (fire, flood, earthquake, etc.) *Description of hardship *Estimated damage valueHome status *OwnedRentedExtent of damage *Completely destroyedPartially damagedHave you received other sources of assistance? *YesNoIf yes, please provide source(s) and amount(s) *Requested Relief Amount *Please provide answer * = Submit
